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Nutrition and Chronic Pain
- Background
- Soy Bean Oil
- Omega-3 Acids
- Anthocyanins
- Glucosamine Sulphate
- Vitamin D
- Vitamin E
- L-Tryptophane & Pyridoxine
- Zinc
- Selenium
- References
Background
- Pain and Injury cause release of inflammatory mediators including Interleukins (e.g. IL-6) and Tumour-Necrosis Factor-alpha (TNF-α)
- The release of these mediators in turn results in oxidative stress with free oxygen radicals causing damage to mitochondria, DNA and cell membranes.
- A variety of nutritional compounds have been utilised in experimental and clinical settings to counteract this damage. Indeed, some of these nutrients have been shown to clinically reduce pain in selected patient groups.
Soy Bean Oil
- Soy Beans are a natural source of isoflavones
- Flavonoids (phytochemicals) are chemical structure analogues to mammalian oestrogen and are:
- antimutagenic
- antiproliferative
- antioxidant
- anti-inflammatory
- cardioprotective
- Rats, which had had a soy protein-rich diet prior to a partial sciatic nerve injury, showed significantly reduced pain behaviour compared with rats who had a normal diet. This effect was pre-emptive, not palliative (i.e. soy-rich food did not act as an analgesic when given after the injury). (Perez et al. 2005)
- This analgesic effect is believed to be due to reduction in TNF-α in macrophages via increased concentrations of Omega(ω)-3.
Omega(ω) -3 and Omega (ω) -6 Acids
- ω-3 Polyunsaturated fatty acids (PUFA) is converted to eicosapentanoic acid (EPA), an agent which suppresses inflammation and pain
- The balance of ω-3 to ω-6 is critical. Our modern diet in NZ is high in Sunflower Oil (ω-6 : ω-3 = 650 : 1) which makes the diet pro-inflammatory.
- Fish Oil provides precursors to EPA and docasohexanoic acid (DHA) which result in a less inflammatory state.
- In summary; ω-3 PUFAs result in
- decreased production of inflammatory eicosanoids
- increased production of anti-inflammatory mediators (resolvins and protectins)
- suppress Natural Killer Cell activity
- suppress lymphocyte proliferation (precursor alpha-linoleic acid is much less effective)
- A typical dose is 3-3.5 g/day of fish oil capsules has shown significant improvement in tender joints and morning stiffness when given to patients with osteoarthritis
- A study in 66 patients with Rheumatoid Arthritis revealed similar efficacy between patients taking 130 mg/kg omega-3 fish oil compared with 75 mg Diclofenac. Patients taking dietary supplements of fish oil exhibit improvements in clinical parameters of disease activity from baseline, including the number of tender joints, and these improvements are associated with significant decreases in levels of IL-1 beta from baseline. Some patients who take fish oil are able to discontinue NSAIDs without experiencing a disease flare. (Kremer at al.)
- 250 patients who had been seen by a neurosurgeon and were found to have nonsurgical neck or back pain were asked to take a total of 1200 mg per day of omega-3 EFAs (eicosapentaenoic acid and decosahexaenoic acid) found in fish oil supplements. Seventy-eight percent were taking 1200 mg and 22% were taking 2400 mg of EFAs. Fifty-nine percent discontinued to take their prescription NSAID medications for pain. Sixty percent stated that their overall pain was improved, and 60% stated that their joint pain had improved. Eighty percent stated they were satisfied with their improvement, and 88% stated they would continue to take the fish oil. There were no significant side effects reported (Maroon and Boost 2006).
Anthocyanins
- Plant-derived compounds which are cellular antioxidants and anti-inflammatory agents (phenolics and polyphenolics)
- Sour cherries have been reported to reduce pain from arthritis and gout.
Glucosamine Sulphate (GS)
- Compound found naturally in the body and is extracted from shellfish
- Aminosugar that links together in chains to form part of the structural matrix of cartilage.
- GS stimulates cartilage synthesis and protects against breakdown.
Vitamin D
- A review of 51 articles that focused on vitamin D deficiency and its musculoskeletal manifestations showed a direct correlation between vitamin D deficiency and musculoskeletal pain. (Heath and Elovic 2006)
- Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and worsens proximal muscle strength and postural sway.
- Development and progression of osteoarthitis and Rheumatoid Arthritis is faster in patients with poor Vitamin D status.
- Vitamin D deficiency and osteomalacia should be considered in the differential diagnosis of patients with musculoskeletal pain, fibromyalgia, chronic fatigue syndrome, or myositis.
- Vitamin D status is determined by measurement of serum 25-hydroxyvitamin D (recommended serum level : 30 - 60 ng/mL)
- Management : 1000 IU of vitamin D(3) per day or 50,000 IU of vitamin D(2) every 2 weeks
Vitamin E
- Vitamin E is frequently recommended by sufferers from Trigeminal Neuralgia and virtually no TNA-Newsletter goes by without mentioning of the positive outcomes of Vitamin E in this patient group.
- Indeed, a randomised controlled trial is under way in Australia to research this issue.
- 6 patients with confirmed chronic pancreatitis were randomized to receive treatment with either Antox, which contains the antioxidants selenium, betacarotene, L-methionine, and vitamins C and E, or placebo for 10 weeks. Treatment with Antox was associated with significant improvements in quality of life in terms of pain (+17 antioxidant vs. -7 placebo), physical (+9 vs. -3) and social functioning (+8 vs. -7), and general health perception (+10 vs. -3). (Kirk et al. 2006)
- In animal experiments Vitamin E produces analgesia in neuropathic rats that is, at least in part, mediated by reducing central sensitization which, in turn, is induced by peripheral nerve injury (Kim et al. 2006)
L-Tryptophane and Pyridoxine (Vit. B6)
- The clinical action of this combination may be similar to low-dose TCAs.
- Some clinicians utilise Pyridoxine 25 mg and very low-dose Amitriptyline (e.g. 5 or 10 mg) in cases where Amitriptyline alone has resulted in significant side effects.
- Excellent food resources for this combination are Bananas, Avocados and Nuts.
Zinc
- Zinc is anti-inflammatory and supports joint cartilage synthesis in doses of 12-15 mg / day.
Selenium
- New Zealand's soil has very little selenium content, a factor which has been attributed to some pain conditions.
References
- Artus M, Croft P, Lewis M. The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain. BMC Fam Pract. 2007 May 4;8:26. [pubmed]
- Bagga D, Wang L, Farias-Eisner R, et al. Differential effects of prostaglandin derived from omega-6 and omega-3 polyunsaturated fatty acids on COX-2 expression and IL-6 secretion. Proc Natl Acad Sci U S A 2003;100:1751–6. [pubmed]
- Cleland LG, James MJ, Proudman SM. The role of fish oils in the treatment of rheumatoid arthritis. Drugs. 2003;63(9):845-53. [pubmed]
- Gerwin RD. A review of myofascial pain and fibromyalgia--factors that promote their persistence. Acupunct Med. 2005 Sep;23(3):121-34. [pubmed]
- Heath KM, Elovic EP. Vitamin D deficiency: implications in the rehabilitation setting. Am J Phys Med Rehabil. 2006 Nov;85(11):916-23. [pubmed]
- Kennedy M, Bruninga K, Mutlu EA, Losurdo J, Choudhary S, Keshavarzian A. Successful and sustained treatment of chronic radiation proctitis with antioxidant vitamins E and C. Am J Gastroenterol. 2001 Apr;96(4):1080-4. [pubmed]
- Kim HK, Kim JH, Gao X, Zhou JL, Lee I, Chung K, Chung JM. Analgesic effect of vitamin E is mediated by reducing central sensitization in neuropathic pain. Pain. 2006 May;122(1-2):53-62. [pubmed]
- Kirk GR, White JS, McKie L, Stevenson M, Young I, Clements WD, Rowlands BJ. Combined antioxidant therapy reduces pain and improves quality of life in chronic pancreatitis. J Gastrointest Surg. 2006 Apr;10(4):499-503. [pubmed]
- Kremer JM, Lawrence DA, Petrillo GF, Litts LL, Mullaly PM, Rynes RI, Stocker RP, Parhami N, Greenstein NS, Fuchs BR, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995 Aug;38(8):1107-14. [pubmed]
- Maes M, Mihaylova I, Leunis JC. In chronic fatigue syndrome, the decreased levels of omega-3 poly-unsaturated fatty acids are related to lowered serum zinc and defects in T cell activation. Neuro Endocrinol Lett. 2005 Dec;26(6):745-51. [pubmed]
- Maroon JC, Bost JW.Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31. [pubmed]
- Pérez J, Ware MA, Chevalier S, Gougeon R, Shir Y. Dietary omega-3 fatty acids may be associated with increased neuropathic pain in nerve-injured rats. Anesth Analg. 2005 Aug;101(2):444-8. [pubmed]
- Shinchuk L, Holick MF. Vitamin d and rehabilitation: improving functional outcomes. Nutr Clin Pract. 2007 Jun;22(3):297-304. [pubmed]